Journal of Korean Medical Science, 2019. 34(17), e133-, DOI: https://doi.org/10.3346/jkms.2019.34.e133

Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure

Min-Soo Ahn, Byung-Su Yoo; Junghan Yoon; Seung-Hwan Lee; Jang-Young Kim; Sung Gyun Ahn; Young Jin Youn; Jun-Won Lee; Jung-Woo Son; Hye Sim Kim; Dae Ryong Kang; Sang Eun Lee; Hyun-Jai Cho; Hae-Young Lee; Eun-Seok Jeon; Seok-Min Kang; Dong-Ju Choi; Myeong-Chan Cho

Abstract

BACKGROUND: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately.

METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist.

RESULTS: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34-0.95), mortality (HR, 0.41; 95% CI, 0.24-0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36-0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41-0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47-0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint.

CONCLUSION: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.

• DOI: https://doi.org/10.3346/jkms.2019.34.e133
• ISBN or ISSN: 1011-8934

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.